Newer tools to assess socioeconomic status of Indian households.

Abstract

“Let there be no distinction between rich and poor, high and low.” – The Collected Works of Mahatma Gandhi, Publications Division XXVI – 199 Dear Editor, Ananthan in May 2021 issue of the Journal highlights modified Kuppuswamy scale for (measuring) socioeconomic status of an Indian family – Update based on new CPI (IW) series from September 2020 (data). Recently Labour Bureau, Government of India revised base year of existing CPI (IW) series from 2001 to 2016 and this letter updates the income ranges for Modified Kuppuswamy scale on this basis.[1] Notwithstanding what effect the economic revision will have on assessing socioeconomic status of an Indian family, we disagree with the basic assumption that this status is one of the most important determinants of health status of a family. If we look at current status of various States of our nation, there is a hidden lesson in relationship (or its lack) between average income per person (Net State domestic Product) and various health indicators. National Institute for Transforming India (NITI Aayog) – a government body – in collaboration with World Bank released Healthy States – Progressive India, which has a Report on the Ranks of States and Union Territories, two years ago. The Report counts on as basic health services indicators as vacancy of Medical Officers at PHCs and of Specialists at District Hospitals, proportion of functional 24 × 7 PHCs and proportion of ANC registered within first trimester against total registrations etc., It has a Figure E1 – Larger States: Incremental scores and ranks with overall performance on page 17. What this figure highlights is that Kerala is the best overall performer in ensuring welfare of its citizens, whereas richer ones like Karnataka and Telangana lag behind. Similarly, Figure E.4 on page 21 of the Report provides us a relationship between composite Health index score (a measurement of health indicators) and per capita State Domestic Product (for income). If health indicators are simple products of income, the relationship should be linear. But surprisingly that is not the case. States higher on the y axis are better social performers where Kerala tops the graph. What is striking to observe is that several other States – despite having similar wealth fare – not as good as this one. We need to learn a simple lesson from this official report[2] and others[3] that higher funds don’t automatically translate into indicators for making our lives better and much complexities exist in between. Another basic indicator of health of a society is that how many women die during childbirth. Here UNICEF provides an updated map of maternal mortality ratio.[4] When we look at it, what is obvious is that Thailand, Sri Lanka. Malaysia and Vietnam have very low figures whereas they don’t have much higher income per person than us. Hence we learn while looking around is that relationship between economic status and health indicators is complex one and several factors, for example improvement of primary and preventive care as well as providing universal basic education play a strong intermediate role to decide final outcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. We accessed all the webpages while submitting this letter to the Editor.